ECONOMIC  ASPECT  OF 
LENGTHENING  HUMAN  LIFE 


BY 


Prof.  IRVING  FISHER 

of  Yale  University 
resident  of  the  Committee  of  One  Hundred  on  National  Health 


^ 


Addrsss  delivered  before 


fesociATioN  OF  Life  Insurance  Prej8*©ents 


New  York,  February  5,  1909 


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ECONOMIC  ASPECT  OF  LENGTHENING  HUMAN  LIFE. 

By  Professor  Irving  Fisher  of  Yale  University, 
President  of  the  Committee  of  One  Hundred  on  National  Health. 


Concerted  action  by  life  insurance  companies  to  lengthen  human 
life  would  mark,  I  believe,  one  of  the  greatest  steps,  if  not  the  great- 
est step,  ever  yet  taken  toward  the  improvement  of  human  longevity. 
The  nearest  analogy  is  perhaps  to  be  found  in  the  work  of  fire 
insurance  companies  in  reducing  the  number  of  fires.  But  it  is  a 
general  truth  that  the  best  success  of  any  movement  is  found  only 
when,  in  a  sense,  it  reaches  the  commercial  stage — in  other  words, 
when  it  is  made  to  pay  in  some  tangible  way.  Philanthropy  is  keen 
to  lead  the  way  to  reform,  but  becomes  a  broken  reed  if  depended 
upon  for  its  support  continuously  or  on  a  large  scale. 

The  insurance  men  whom  I  have  consulted  as  to  whether  it 
would  pay  to  engage  in  the  saving  of  lives  have  been  unanimously 
affirmative  in  their  answers.  So  obvious  does  this  seem  that  the 
question  arises,  why  have  insurance  companies  never  attempted  it 
before  ?    There  seem  to  be  three  explanations : 

First,  the  continuance,  until  recently,  of  the  tradition  that 
human  mortality  follows  a  nearly  invariable  law,  and  a  law  which 
can  not  be  appreciably  affected  by  any  act  of  man. 

Second,  after  it  became  known  to  experts  that  human  life  is 
greatly  extensible  through  public  and  private  hygiene,  this  knowl- 
edge was  possessed  by  so  few,  that  the  general  public,  and  even  the 
rank  and  file  of  the  medical  profession,  remained  of  the  contrary 
belief,  and  the  inertia  of  their  conservative  opinion  prevailed. 

Third,  it  seemed  too  large  a  task  for  any  one  company  to  pro- 
long life  for  the  whole  country,  and  there  seemed  no  way  to  pro- 
long the  lives  of  its  own  policy-holders  alone,  so  long  as  unsanitary 
conditions  prevailed  throughout  the  communities  in  which  these 
policy-holders  lived,  while  finally  there  seemed  no  way  of  bringing* 
the  various  life  insurance  interests  to  agree  on  concerted  action. 

It  seems  now,  however,  that  the  time  has  arrived  when  all  three 
of  these  objections  can  be  removed.  I  assume  that  before  this> 
audience  there  is  no  need  of  presenting  evidence  or  arguments  to> 


prove  that  human  life  may  be  lengthened  by  hygienic  measures,  and 
shall  therefore  merely  run  over  very  briefly  the  most  salient  and 
general  facts,  as  introductory  to  the  formulation  of  a  practical  plan 
of  action. 

It  has  long  been  known  that  there  is  no  iron  law  of  mortality, 
but  that  mortality  depends  on  the  hygienic  state  of  the  community. 
Baines,  in  a  recent  paper  in  the  Journal  of  the  Royal  Statistical 
Society,  has  calculated  that  the  average  duration  of  life  in  India 
is  only  twenty-three  years  for  males  and  twenty-four  years  for 
females,  or  less  than  half  the  life  span  in  the  advanced  countries  of 
Europe.  The  estimates  of  Finkelnburg  show  that  in  Europe  human 
life  has  probably  doubled  in  the  last  350  years.  More  recent  and 
more  reliable  figures  show  that  life  is  lengthening  to-day  more 
rapidly  than  ever.  If  we  take  life  tables  for  different  periods  for 
England,  France,  Prussia,  Denmark,  Sweden,  and  Massachusetts, 
we  find  that  human  life  lengthened  during  the  Seventeenth  and 
Eighteenth  Centuries  at  the  rate  of  four  years  per  century;  that 
during  the  first  three-quarters  of  the  Nineteenth  Century  it 
lengthened  at  the  rate  of  about  nine  years  per  century;  that  at 
present  it  is  lengthening  in  Europe  generally  at  the  rate  of  seventeen 
years  per  century,  and  in  Prussia  (which  is  perhaps  the  home  of 
preventive  medicine)  at  the  rate  of  27  years  per  century.  For  this 
country  the  rate  can  only  be  judged  from  the  statistics  for  Massa- 
chusetts, which  show  that  life  is  lengthening  by  about  fourteen 
years  per  century,  or  approximately  half  of  the  Prussian  rate. 
These  rates  may  not  continue  in  the  future,  but  the  opinion  of 
our  best  authorities  on  longevity,  such  as  Ray  Lankester  and  Metch- 
nikoff,  is  that  there  is  still  great  room  for  improvement  especially 
after  middle  life.  Hitherto  almost  all  the  improvement  has 
applied  to  ages  before  fifty  and  only  the  most  recent  figures  show 
any  tendency  toward  improvement  beyond  that  age.  It  is  significant 
that  backward  India — in  spite  of  the  enormous  room  for  improve- 
ment— shows  during  twenty  years  no  rate  of  improvement  whatever. 

The  statistics  of  insured  lives  show  that  the  insured  poor,  as 
represented  by  the  Industrial  Companies,  have  a  mortality  from 
fifty  to  eighty  per  cent,  higher  than  the  insured  rich  or  well-to-do, 
as  represented  in  the  ordinary  insurance  companies.  The  unsani- 
tary districts  of  Glasgow  and  Paris  show  a  mortality  more  than 
double  that  of  the  sanitary  districts,  while  cities  in  general  show  a 
much  higher  mortality  than  the  open  country.  A  fall  of  the  death 
rate  always  promptly  follows  sanitation.    Colonel  Gorgas  cut  the 


death  rate  in  Havana  in  two,  bringing  it  down  to  between  20 
and  24  per  1000.  The  New  York  death  rate  responded  at  once  to 
Colonel  Waring's  clean  streets,  and  that  of  Rochester  to  Dr.  Goler's 
milk  crusade.  And  now  it  is  announced  that  the  death  rate  of 
New  York  is  16.5,  the  lowest  on  record — a  result,  in  all  human 
probability  due  to  the  hygienic  work  of  Dr.  Darlington,  the 
efficient  health  officer,  Mr.  Nathan  Straus,  the  milk  reformer,  and 
the  public  agitation  for  health  prosecuted  by  the  New  York  Times, 
the  Journal,  and  other  media,  allied  with  the  health  work  of  the 
Committee  of  One  Hundred  on  National  Health,  the  Tuberculosis 
Association  and  Committees,  and  other  organizations. 

These  and  other  facts  and  the  mass  of  detailed  figures  which 
they  represent  show  conclusively  that  human  life  is  long  or  short 
precisely  according  to  the  hygienic  conditions  under  which  it  is 
lived ;  that  human  life  can  be  prolonged  as  these  hygienic  conditions 
are  improved,  and  that  there  is  still  enormous  room  for  improve- 
ment. Farr,  twenty  years  ago,  in  his  masterly  work  on  Vital 
Statistics,  stated  that  any  community  could  attain  an  average  dura- 
tion of  life  equal  to  that  in  the  so-called  "healthy  districts"  of 
England  where  the  average  duration  of  life  was  then  fifty-one  years. 
To  bring  all  England  up  to  this  level  would  at  that  time  mean  a 
lengthening  of  life  by  one-fifth,  or  twenty  per  cent. 

A  report  which  I  have  recently  prepared  for  the  Conservation 
Commission,  based  on  data  contributed  from  acknowledged  Ameri- 
can authorities,  shows  that  human  life  in  America  could,  by  the 
adoption  of  hygienic  reforms  already  known  and  entirely  practic- 
able, be  lengthened  by  over  one-third — that  is,  over  fifteen  years. 
This  calculation  has  been  made  very  conservatively  and  is  prob- 
ably several  years  inside  the  truth.  The  statistics  and  estimates  on 
which  it  is  based  have  been  taken  from  published  sources,  as  well 
as  contributed  by  some  score  of  American  authorities — medical, 
actuarial,  and  hygienic. 

A  safe  minimum  estimate  was  made*  of  the  degree  of  pre- 
ventability  of  the  deaths  from  each  of  the  ninety  principal  causes 
of  death  in  the  United  States.  For  instance,  for  typhoid  fever, 
experience  in  Lawrence,  Massachusetts,  has  shown  that  the  intro- 
duction of  a  public  water  filter  reduced  the  typhoid  mortality  by 
eighty  per  cent.  In  Munich  the  cleaning  of  cesspools  and  other 
hygienic  measures  reduced  the  mortality  from  typhoid  by  ninety- 
seven  per  cent.  On  the  basis  of  these  and  other  facts,  it  was  con- 
servatively estimated  that  eighty-five  per  cent,  of  the  deaths  now 


occurring  from  typhoid  fever  in  the  United  States  could  be  easily 
prevented.  Professor  Sedgwick  recently  announced  the  truth  of 
Hazen's  theorem — that  for  each  life  saved  from  typhoid,  two  or 
three  lives  are  saved  from  other  diseases.  This  cumulative  effect, 
however,  was  not  taken  into  account  in  the  calculations,  nor  was 
account  taken  of  the  constant  advance  being  made  in  preventive 
medicine. 

For  these  and  other  reasons,  the  calculated  estimate  of  the 
improvability  of  human  life  is  regarded  as  ultra-conservative. 
Tuberculosis  is  known  to  be  preventable.  In  my  table,  it  is  entered 
as  only  seventy-five  per  cent,  preventable;  pneumonia  as  forty-five 
per  cent,  preventable ;  typhoid  as  eighty-five  per  cent. ;  diphtheria, 
seventy  per  cent.  These  conservative  figures  are  among  the  highest 
allowed.  Many  diseases,  such  as  cancer,  are  recorded  in  the  table 
as  zero  per  cent,  preventable,  although  the  best  expert  opinion 
would  allow  some  degree  of  preventability,  if  prevention  begins 
early  enough  in  life. 

On  the  basis  of  these  ratios  of  preventability,  or  rather  post- 
ponability  of  death,  has  been  computed  the  possible  extension  of 
the  average  human  life  <by  saving  lives  now  lost  by  preventable  di- 
seases. The  calculation  is  made  on  the  assumption  that  those  thus 
saved  from  death  enjoy  as  their  new  lease  of  life  only  the  expecta- 
tion of  life  now  belonging  to  their  respective  ages.  This  assump- 
tion is  very  conservative,  for  it  means  that  lives  once  saved  shall 
receive  no  further  benefits  from  improved  mortality,  but  shall  die 
off  at  the  old  rates  of  mortality. 

Even  on  these  safe  premises  of  partial  postponability  of  deaths, 
we  find  that  about  two  years  of  the  possible  lengthening  of  human 
life  would  be  due  to  the  elimination  of  preventable  tuberculosis; 
.6  of  a  year  to  the  elimination  of  preventable  typhoid;  .5  to  the 
elimination  of  preventable  diphtheria;  .9  to  the  elimination  of  pre- 
ventable accidents.  It  is  estimated  that  at  least  eight  years  could 
be  added  to  human  life  merely  by  securing  reasonably  pure  air, 
water  and  milk. 

A  grouping  by  ages  will  bring  home  these  figures  to  life  insur- 
ance companies.  It  was  estimated  that  for  diseases  of  infants  under 
one  year  of  age,  such  as  broncho-pneumonia,  diarrhoea  and  enteritis, 
at  least  half  of  the  deaths  were  preventable — ^that  is,  postponable. 
For  diseases  of  childhood  such  as  meningitis,  diphtheria  and  scarlet 
fever,  the  same  is  true ;  for  diseases  of  middle  life,  such  as  t)rphoid 
fever,  tuberculosis,  pneumonia  and  accidents,  over  one-third  are 


postponable;  and  for  diseases  of  late  life,  such  as  Bright's  disease, 
heart  disease  and  apoplexy,  at  least  one-fourth  of  the  deaths  are 
postponable. 

These  ratios  may  seem  high  at  first  glance,  but  only  because 
no  one  has  previously  attempted  to  assemble  all  ratios  of  prevent- 
ability.  Each  investigator  has  seen  clearly  the  preventability  within 
his  own  special  sphere,  but  assumed  that  outside  that  sphere  the 
preventability  was  less.  One  specialist  knows  that  tuberculosis  is, 
for  the  most  part,  preventable ;  another,  typhoid ;  a  third,  diphtheria ; 
a  fourth,  infantile  diarrhoea.  And  yet  each  clings  to  the  idea  that 
disease  in  general  is  unpreventable.  Some  of  the  very  experts  of 
the  Yale  Medical  School  and  State  and  Federal  health  officers  who 
contributed  the  individual  estimates — and  these  experts  include 
eighteen  of  the  best  and  safest  authorities  in  the  United  States — 
have  been  surprised  to  find  how  large  in  the  aggregate  the  resultant 
preventability  is.  It  shows  that  over  a  third  of  all  deaths  which 
now  occur  could  be  prevented — that  is  to  say,  deferred.  Every 
precaution  has  been  taken  to  make  these  figures  so  safely  within 
the  truth  as  to  avoid  the  possibility  of  any  reasonable  criticism. 
I  will  add  that  those  who  contributed  the  statistics,  estimates,  and 
expert  guesses  on  which  these  aggregates  are  based  were  especially 
urged  to  be  conservative.  The  eighteen  estimators  included  Drs. 
Flint,  Blumer,  Swain  and  Osborne  of  the  Yale  Medical  School; 
Dr.  Wilbur,  Chief  of  Vital  Statistics  of  the  United  States;  Health 
Officers  Townsend  of  Connecticut,  Baker  of  Michigan,  Wright  of 
New  Haven,  Woodward  of  Washington,  Chapin  of  Providence,  etc. 
These  gentlemen  made  their  estimates  independently,  but  they 
agreed  remarkably  well.  This  would  indicate  that  they  were  cor- 
rect. These  gentlemen  are  not  given  to  exaggeration,  but  even  if 
their  estimates  are  three  times  too  great,  the  preventable  deaths  still 
exceed  ten  per  cent. 

By  working  out  the  ratios  of  preventability  for  each  of  the  prin- 
cipal causes  of  death,  it  is  possible  to  construct  an  ideal  survivor- 
ship table  which  may  then  be  compared  with  existing  survivorship 
tables.  Actuaries'  tables  show  that  a  reduction  of  one-third  in 
mortality  would  enable  the  premium  to  be  reduced  by  over  fifteen 
per  cent.  Even  if  only  a  third  of  this  possible  reduction  were 
obtained,  or  five  per  cent.,  the  insured  in  the  United  States  would 
be  saved  many  millions  annually.  Of  course  whatever  saving  is  pos- 
sible could  not  be  secured  without  effort  or  cost.  Not  all  of  it 
could  be  obtained  at  once,  and  some  of  it  could  be  obtained  whether 


insurance  companies  took  a  hand  or  not.  But  by  so  doing  they  can 
greatly  accelerate  the  improvement.  While  it  would  be  manifestly 
impossible  to  estimate  exactly  what  returns  could  be  made  on  the 
investment,  it  is  clear  that  even  if  the  most  meagre  returns  could 
be  secured,  the  gain  would  pay. 

It  can  scarcely  be  imagined  that  the  companies  would  lose 
anything.  I  understand  that  $200,000  a  year  is  about  two  cents  per 
$1,000  of  insurance  carried.  It  would  be  strange  if  $200,000 
could  not  be  expended  in  such  a  manner  as  to  secure  a  saving  of 
a  postage  stamp  a  year  on  each  $1,000  policy!  As  one  of  your 
actuaries,  Mr.  Messenger,  has  shown,  $200,000  is  only  one-eighth  of 
one  per  cent,  of  present  annual  death  claims. 

The  chance  of  failure  is  further  reduced  when  we  remember 
that  the  effect  in  reducing  mortality  is  progressive  or  cumulative, 
while  no  cumulative  effect  is  needed  to  return  the  money  invested. 

The  conclusion  seems  safe  that  here  is  a  rich  unexploited  field 
for  saving  money.  And  the  beauty  of  it  is  that  these  gains  bring 
with  them  gains  far  more  precious  to  the  nation  than  dollars — 
immeasurable  gains  of  longevity,  vitality,  efficiency,  and  happiness. 
Life  insurance  is  not  philanthropy,  but  it  is  a  beneficent  business. 
Though  at  first  glance  it  might  seem  that  to  prevent  the  pollution 
of  streams,  to  improve  the  milk  supply,  to  obtain  pure  foods,  and 
freedom  from  accident  is  no  part  of  the  business  of  life  insurance, 
yet  it  is  easy  enough  to  see  the  very  vital  connection.  By  far  the 
larger  part  of  the  cost  of  the  insurance  business  is  not  management 
nor  agents'  fees  but  cost  of  mortality.  It  is  the  right,  if  in  fact  it 
is  not  the  duty,  of  any  business  to  reduce  its  cost.  To  pare  down 
salaries  might  not  save  the  policy-holder  one  per  cent,  of  his 
premium,  but  to  reduce  mortality  cost  might  save  him  many  per 
cent. 

Another  point  may  be  emphasized.  The  mere  announcement 
that  insurance  companies  intended  to  improve  health  conditions 
would  have  an  effect  in  improving  those  conditions.  This  effect 
would  be  felt  in  two  ways:  First,  it  would  convince  millions  of 
the  ignorant  and  indifferent  that  the  public  health  movement  must 
have  substantial  merit  to  be  an  object  of  interest  by  life  insurance 
companies.  People  are  easily  led  by  those  whose  opinions  they 
respect.  In  spite  of  the  great  progress  of  the  health  movement, 
there  are  still  vast  hordes  of  our  people  who  know  nothing  of  it. 
Knowledge  of  its  merits  is  largely  confined  to  scientific  and  medical 
men,  who  constitute  only  a  small  fraction  of  the  population.    The 


actuaries  and  medical  boards  and  other  insurance  officials  constitute 
a  still  smaller  class.  Yet  these  classes  can  easily  sway  the  whole. 
The  second  way  in  which  the  mere  announcement  of  your  purpose 
to  labor  for  health  would  have  immediate  effect  is  in  spurring 
numerous  officials  and  firms  to  reform.  Every  health  officer,  every 
food  manufacturer,  every  milk  dealer  in  the  United  States  that 
heard  of  the  intention  of  the  insurance  companies  to  improve  health 
conditions  would  become  ambitious  to  make  a  good  showing. 
Local  pride  in  every  community  would  result  in  efforts  to 
keep  abreast  of  the  best  records  and  avoid  the  reputation  for  being 
an  unhealthful  place  to  live  in.  Insurance  companies  sometimes 
charge,  I  believe,  higher  rates  for  policies  involving  tropical  resi- 
dence, but  in  the  United  States  are  not  allowed  to  make  local  dis- 
crimination. There  is,  therefore,  all  the  more  reason  why  they 
might  properly  endeavor  to  lower  the  mortality  in  say  Mississippi — 
if  the  mortality  is  high  there — in  order  that  they  might  be  enabled 
to  do  business  there. 

In  the  history  of  fire  insurance,  the  mutual  companies  first 
made  the  effort  to  reduce  fire  risks.  When  the  importance  of  ex- 
ercising the  function  of  preventing  fires,  as  well  as  indemnifying 
against  fires,  once  entered  into  the  plans  of  stock  companies,  they 
soon  overtook,  if  they  did  not  outrun,  the  mutual  companies  in  the 
success  of  their  efforts.  It  is  estimated  that  the  risk  from  fire  in 
certain  particular  classes  has  been  reduced,  through  the  fire  insur- 
ance companies,  some  seventy  per  cent.  In  New  England  seventy 
years  ago  the  rate  on  cotton  and  woolen  mills  averaged  three  or 
four  dollars  per  hundred.  To-day  these  mills  are  being  insured 
at  a  total  cost  per  annum  of  seven  cents  per  hundred.  In  some  cases 
the  cost  has  been  reduced  to  i/ioo  of  the  former  amount.  This 
enormous  decrease  has  been  accomplished  by  slight  expenditures. 
In  some  factories  the  cost  of  improvements  have  been  more  than 
paid  for  in  the  saving  of  premiums  for  fire  insurance  in  one  year. 
The  stock  companies  were  forced  by  the  competition  of  the  mutual 
companies  to  take  up  preventive  measures.  They  now  employ  fire 
insurance  engineers  to  maintain  a  laboratory  in  Chicago  which  is 
well  equipped  for  the  purpose  of  studying  fire-resisting  materials, 
fire-resisting  devices,  new  apparatus  and  fire  prevention  in  general. 
Many  fire  insurance  men  believe  that  this  laboratory  is  their  best 
investment.  No  reduction  in  rate  is  guaranteed  until  fire  fighting 
devices  are  approved  by  the  laboratory.  Now  that  the  stock  com- 
panies have  gone  into  this  work  of  fire  prevention  systematically, 


~  8 

they  are  regaining  the  ground  that  they  had  lost  by  allowing  the 
mutuals  to  get  ahead  of  them: 

In  employers'  liability  insurance,  the  idea  of  prevention  has 
made  great  headway.  Here  the  companies  are  all  stock  companies, 
but  they  have  learned  that  their  function  is  not  simply  to  distribute 
losses,  but  to  lessen  them  as  well.  So  also  accident  companies  have 
aided  in  passing  laws  which  tend  to  prevent  accidents  to  life  and 
limb.  Here  they  have  reached  the  very  threshold  of  public  health. 
It  is  manifest  destiny  that  if  insurance  companies  now  aid  in  legis- 
lation to  save  the  arms  and  legs  of  workmen,  they  will  soon  aid 
in  legislation  to  save  lives  also.  In  fact,  protection  from  accidental 
injury,  is  also  protection  from  accidental  death;  and  if  you  strive 
to  reduce  the  deaths  from  accident,  why  not  reduce  the  deaths  from 
other  causes?  If  casualty  companies  work  for  improved  safety, 
why  should  not  life  companies  work  for  improved  sanitation  and 
improved  hygiene  in  general?  In  fact,  the  Industrial  Departtnent 
of  the  Metropolitan  Company  has  just  announced  that  if  prevention 
of  tuberculosis  and  reduction  of  the  death  rate  will  give  cheaper 
insurance,  the  Company  hopes  to  co-operate  with  existing  agencies 
for  the  eradication  of  this  and  other  diseases,  and  to  place  at  their 
disposal  its  machinery  and  the  statistical  material  which  it  has 
gathered  since  its  organization. 

According  to  the  plans  which  I  have  in  mind,  the  money 
to  be  invested  in  life-saving  would  be  largely  in  the  edu- 
cation of  the  public  and  especially  policy-holders  in  health 
matters,  and  co-operation  in  every  legitimate  way  to  improve 
the  public  health  offices  and  service  in  the  municipalities, 
states  and  the  Federal  Grovernment.  In  this  latter  way, 
the  result  of  the  expenditure  of  money  by  the  insurance  com- 
panies would  be  to  induce  the  Government  to  spend  much  larger 
sums,  and  the  money  invested  by  the  insurance  companies  would 
be  multiplied  in  efficiency  several  fold.  If,  for  instance,  by  the 
expenditure  of  $200,000  a  year  the  public  throughout  the  country 
could  be  made  to  appreciate  the  importance  of  clean  streets,  pure 
water  supply,  etc.,  sufficiently  to  result  in  municipal  expenditure  by 
the  cities  of  the  United  States  for  public  health  of  an  additional 
$20,000,000  which  would  otherwise  not  have  been  made,  every 
dollar  invested  would  be  multiplied  a  hundred  fold.  In  other  words, 
the  insured  lives  would  not  have  to  carry  the  entire  load,  but  could 
induce  the  tax-payer  to  do  his  share.  Our  public  health  laws  and 
administration  leave  vast  room  for  improvement.     As  Dr.  Welch 


has  said  neglect  of  public  health  is  a  disgrace  to  the  nation.  ScMne 
states  have  no  boards  of  health.  Few  have  good  ones.  A  minority 
have  accurate  registration  of  deaths  and  not  one  has  accurate 
registration  of  births.  We  therefore  lack  even  the  first  step  to- 
ward efficient  national  health  protection — good  vital  statistics. 

Just  as  fire  insurance  companies  endeavor  to  secure  in  munici- 
palities adequate  fire  protection,  so  life  insurance  companies  might 
properly  endeavor  to  secure  adequate  municipal  health  protection, 
and  they  might  likewise  bring  their  influence  to  bear  in  securing  the 
passage  of  model  health  laws  by  our  states  in  respect  to  slaughter 
houses,  pure  food  and  other  health  reforms.  The  present  great  and 
needless  waste  of  human  life,  brings  its  heavy  financial  weight 
largely  on  insurance  companies.  The  Prudential  Company  pays  out 
annually  $800,000  for  death  claims  on  account  of  tuberculosis 
alone,  a  disease  which  is  known  to  be  preventable. 

As  to  a  practical  plan  for  participation  by  the  life  insurance 
companies  in  the  health  movement,  two  methods  suggest  themselves. 
The  first  is  for  the  life  insurance  companies,  in  combination,  to 
establish  their  own  machinery  for  disbursing  funds  intended  to 
improve  the  public  health.  The  second  is  to  contribute  to  one  or 
more  organizations  already  existing  for  this  purpose.  I  shall  speak 
in  favor  of  the  second,  and  in  particular  of  the  advantages  to  be 
obtained  by  using  the  Committee  of  One  Hundred  on  National 
Health,  of  which  I  am  president,  as  the  agent  for  this  distribution. 
I  will  say  at  the  outset,  however,  that  I  think  our  Committee  would 
be  willing,  if  need  be,  to  stand  aside  in  favor  of  any  plan  which 
the  insurance  companies  should  prefer.  We  have  been  interested 
in  this  work  from  a  philanthropic  point  of  view  only,  and  have 
borne  its  burden  because  no  other  organization  was  doing  the  work. 
It  has  been  a  tax  on  our  time  and  purses,  and  we  should,  if  the 
same  work  could  be  done  by  others  without  this  tax,  be  only  too 
ready  to  hand  it  over.  We  believe,  however,  that  there  would 
be  a  distinct  advantage  to  the  insurance  companies  in  utilizing 
our  agency,  instead  of  creating  a  new  one.  Since  the  work  is 
largely  one  of  educating  and  convincing  public  opinion,  it  seems 
an  advantage  that  the  movement  should  have  a  scientific  as  well 
as  a  commercial  flavor.  Our  Committee  was  appointed  by  the 
American  Association  for  the  Advancement  of  Science,  and  con- 
sists, for  the  most  part,  of  men  of  national  reputation.  Our  Vice- 
Presidents  are: 


10 

Rev.  Lyman  Abbott,  New  York. 
Miss  Jane  Addams,  Chicago. 
Mr.  Felix  Adler,  New  York. 
Pres.  James  B.  Angell,  Ann  Arbor. 
Hon.  Joseph  H.  Choate,  New  York. 
President  Charles  W.  Eliot,  Cambridge. 
Archbishop  Ireland,  St.  Paul. 
Hon.  Ben.  B.  Lindsey,  Denver. 
Mr.  John  Mitchell,  New  York. 
Dr.  Wm.  H.  Welch,  Baltimore. 

Again,  there  is  a  great  advantage  in  having  the  movement 
popular  and  under  the  auspices  of  a  popular  league.  Our  Com- 
mittee has  organized  the  American  Health  League^  the  membership 
of  which  is  at  present  23,000.  It  appears  that  this  league  will  have 
a  more  independent  existence  and  its  members  feel  a  greater  esprit 
de  corps  if  conducted  under  its  present  leadership  than  if  given 
over  entirely  to  a  commercial  organization. 

Again,  I  am  told  that  there  would  be  difficulties  in  getting 
agreements  between  various  competing  life  insurance  interests  so 
as  to  form  a  central  committee  in  which  all  would  have  confidence 
as  working  for  a  common  benefit  and  not  for  one  particular  company 
or  companies  to  the  exclusion  of  others.  No  such  difficulty  would 
apply  to  our  organization,  which  is  and  would  naturally  remain 
impartial  so  far  as  the  interests  of  special  companies  are  concerned. 
Saving  life  belongs  to  agencies  which  do  nothing  else.  There  are, 
of  course,  other  organizations  working  for  public  health  aside  from 
the  Committee  of  One  Hundred,  but  these  other  organizations  work 
for  special  health  reforms  and  largely  for  relief  from  the  effects 
of  disease,  rather  than  for  prevention.  It  would  seem,  therefore, 
that  the  Committee  of  One  Hundred  is  the  logical  agency  for  doing 
the  proposed  work,  and  in  this  opinion  I  am  confirmed  by  the  in- 
surance men  whom  I  have  thus  far  consulted. 

As  to  the  method  of  contribution  by  the  insurance  companies, 
several  plans  are  open.  The  most  feasible  and  just  seems  to  me  to 
be  a  plan  by  which  the  life  insurance  companies  shall  deposit  with 
the  treasurer  of  the  Committee  of  One  Hundred,  which  is  the 
Title  Guarantee  &  Trust  Company  of  New  York  City,  a  fund  to 
be  set  aside  as  a  special  fund,  and  the  disbursements  from  it  to 
be  made  only  as  authorized  by  a  committee  appointed  for  this  pur- 
pose by  the  Association  of  Life  Insurance  Presidents.     This  in- 


II 

surance  committee  might  be  called  an  advisory  and  auditing  com- 
mittee, whose  purpose  would  be  merely  to  see  that  the  funds  were 
properly  and  wisely  expended.  They  would  not  need  to  have  the 
responsibility  of  forming  plans  for  their  expenditure,  but  would 
have  the  power  to  prevent  any  expenditure  deemed  improper  or  in- 
advisable. 

The  work,  to  yield  results,  should  be  done  on  a  national  scale — 
ten  times  the  scale  which  our  Committee  has  yet  reached.  Yet  this 
would  be  a  trifling  item  of  cost — equal  to  two  cents  a  year  for 
each  $i,ooo  of  insurance.  The  policy-holder  is  not  likely  to  object 
to  paying  one  postage  stamp  a  year,  especially  when  this  will  be 
largely  used  to  induce  the  governments  to  contribute  larger  sums 
and  when  as  a  consequence  he  is  likely  to  enjoy  the  two-fold  benefit 
of  a  longer  life  and  a  lessened  premium. 

It  would  be  entirely  agreeable  to  the  Committee  of  One 
Hundred  to  put  a  number  of  representatives  of  life  insurance  com- 
panies on  the  Committee  of  One  Hundred  itself  and  if  desired  on 
the  executive  committee,  which  has  the  responsibility  of  doing  the 
actual  work. 

As  to  the  methpds  of  expending  the  proposed  fund  to  be  created 
by  the  insurance  companies,  details  can  be  submitted  to  the  com- 
mittee appointed  to  consider  them.  This  would  include  the  enlarge- 
ment of  our  magazine,  the  pressing  of  health  bills  before 
Congress  and  the  legislatures  of  the  several  states,  the  publication 
and  distribution  of  leaflets  of  information  in  continuation  of  the 
series  of  twenty-six  which  we  have  already  published,  a  campaign 
of  newspaper  publicity  and  education,  especially  through  plate 
matter  prepared  and  given  to  10,000  country  newspapers.  It  would 
also  include  efforts  to  enlarge  the  American  Health  League  so  that 
it  may  fulfill  two  functions :  First,  create  an  interest  in  a  large  num- 
ber of  people  in  healthful  individual  living,  and,  second,  create  and 
formulate  public  opinion  which  shall  secure  public  health  legislation. 

The  extraordinary  success  of  our  movement  thus  far  is  the  best 
guarantee  that  its  success  may  be  greatly  increased.  The  move- 
ment has  swept  along  with  an  increasing  momentum,  which  has 
repeatedly  called  forth,  from  those  at  first  skeptical,  expressions  of 
delight  and  amazement.  The  alliance  with  life  insurance  com- 
panies would  tend  to  the  speedy  completion  of  the  first  task  set 
before  us — the  creation  of  a  powerful  national  organization  of 
public  health  at  Washington.  From  the  first  we  have  felt  that  if 
a  Bureau  of  Health  Information  could  be  established  at  Washington 


12 

which  should  have  as  its  function  the  distribution  of  millions  of 
small  pamphlets  on  health — that  is,  teaching  the  people  how  to  live 
long  and  avoid  the  dangers  which  shorten  life  and  cause  morbidity — , 
this  federal  publicity  would  arouse  a  public  sentiment  which  would 
sweep  all  opposition  before  it.  Such  a  sentiment  when  aroused 
would  work  to  the  greater  harmony  of  all  social  classes.  For  in- 
stance, much  ill-advised  legislation  hampering  business  to  the  detri- 
ment of  both  capital  and  labor  would  give  way  to  direct  legislation 
beneficial  to  labor  by  eliminating  preventable  mortality  and  invalidity 
which  now  cause  the  heaviest  burdens  to  the  poor. 

The  fraternal  societies  have  already  undertaken  this  campaign. 
We  have  contributed  our  matter  to  their  journals,  and  they  have 
addressed  our  meetings.  Fraternal  insurance  companies  have  also 
in  several  instances  established  sanatoria,  and  have  attempted  in 
other  ways  to  lengthen  lives  and  decrease  death  claims. 

In  order  that  you  may  better  know  what  kind  of  work  our 
organization  has  been  doing  and  plans  to  do,  I  will  rehearse  briefly 
the  main  features.  After  two  years  we  have  now  representatives 
in  sixteen  hundred  towns  and  cities  in  the  United  States.  We  hope 
ultimately  to  organize  local  committees  in  all  of  these  towns  similar 
to  a  few  already  organized,  the  last  being  in  Portland,  Oregon. 
Through  these  committees  we  have  brought  pressure  to  bear  on  all 
political  parties.  With  23,000  members,  we  have  friends  in 
almost  every  important  town  in  the  nation.  The  mem- 
bers are  taken  from  among  the  influential  men  in  the  community. 
Some  700,000  pamphlets  and  letters  have  gone  out  from  the  execu- 
tive office,  presided  over  by  our  able  executive  secretary.  Professor 
J.  P.  Norton.  The  cost  of  this  and  other  work  has  been  $28,000, 
and  has  largely  been  contributed  in  small  amounts  by  people  in 
moderate  circumstances.  This  shows  the  diffusion  of  interest. 
Over  a  year  ago  we  planned  to  spend  $250,000  during  1908,  but 
the  panic  closed  up  the  larger  pocketbooks,  and  we  had  to  be  content 
with  such  smaller  contributions  as  we  could  get. 

At  the  outset  we  gained  the  support  of  the  great  men  in  the 
nation.  Ex-President  Qeveland  favored  the  movement,  and  Presi- 
dent Roosevelt  wrote  to  me  a  letter,  a  part  of  which  I  quote: 

"Our  national  health  is  physically  our  greatest  national 
asset.  To  prevent  any  possible  deterioration  of  the  American 
stock  should  be  a  national  ambition.  We  cannot  too  strongly 
insist  on  the  necessity  of  proper  ideals  for  the  family,  for 
simple  living,  and  for  those  habits  and  tastes  which  produce 


^3 

vigor  and  make  men  capable  of  strenuous  service  to  their 
country.  The  preservation  of  national  vigor  should  be  a 
matter  of  patriotism  .  .  .  Federal  activity  in  these  mat- 
ters has  already  developed  greatly,  until  it  now  includes 
quarantine,  meat  inspection,  pure  food  administration  and 
federal  investigation  of  the  conditions  of  child  labor.  It  is 
my  own  hope  that  these  important  activities  may  be  still 
further  developed." 

Later,  in  his  Provincetown  speech,  President  Roosevelt  said : 

"I  also  hope  that  there  will  be  legislation  increasing  the 
power  of  the  National  Government  to  deal  with  certain  mat- 
ters concerning  the  health  of  our  people  everywhere;  the 
Federal  authorities,  for  instance,  should  join  with  all  the 
State  authorities  in  warring  against  the  dreadful  scourge  of 
tuberculosis.  I  hope  to  see  the  National  Government  abreast 
of  the  foremost  State  Governments." 

In  his  message  to  Congress  a  year  ago,  he  emphasized  the  im- 
portance of  our  campaign  in  these  words: 

"There  is  a  constantly  growing  interest  in  this  country  in 
the  question  of  the  public  health.  At  last  the  public  mind  is 
awake  to  the  fact  that  many  diseases,  notably  tuberculosis, 
are  natural  scourges.  The  work  of  the  state  and  city  boards 
of  health  should  be  supplemented  by  a  constantly  increasing 
interest  on  the  part  df  the  National  Government.  The  Con- 
gress has  already  provided  a  bureau  of  public  health  and  has 
provided  for  a  hygienic  laboratory.  There  are  other  valu- 
able laws  relating  to  the  public  health  connected  with  the 
various  departments.  This  whole  branch  of  the  Govern- 
ment should  be  strengthened  and  aided  in  every  way." 

By  the  appointment  of  a  Conservation  Commission,  the  oppor- 
tunity was  given  to  us  to  present  the  measure  of  the  wastes  of 
human  life  in  comparison  with  the  wastes  in  the  forests,  the  soil, 
the  waters  and  the  land.  Co-operating  with  fifty  medical  men  and 
technical  experts,  I  prepared  the  report  for  President  Roosevelt 
which  has  already  been  mentioned. 

In  the  meantime,  the  campaign  for  political  planks  proceeded. 
In  two  months,  three  national  platforms  were  framed  which  con- 
tained planks  in  approbation  of  our  program,  and,  so  far  as  I  know, 
for  the  first  time  in  history  political  parties  took  note  of  public 
health  as  worthy  of  consideration.  The  Republican  national  plat- 
form at  Chicago  contained  this  plank: 


14 

"We  commend  the  efforts  designed  to  secure  greater 
efficiency  in  national  public  health  agencies,  and  favor  such 
legislation  as  will  effect  this  purpose." 

The  Democratic  national  platform  adopted  at  Denver  stated : 

"We  advocate  the  organization  of  all  existing  national 
public  health  agencies  into  a  national  bureau  of  public  health, 
with  such  power  over  sanitary  conditions  connected  with 
factories,  mines,  tenements,  child  labor,  and  other  such  sub- 
jects as  are  properly  within  the  jurisdiction  of  the  Federal 
Government  and  do  not  interfere  with  the  power  of  the 
States  controlling  public  health  agencies." 

The  Independence  League  party  adopted  an  even  broader  plank 
in  favor  of  a  National  Department  of  Health,  and  Mr.  Arthur 
Brisbane  has  warmly  supported  in  the  Hearst  journals  the  move- 
ment to  protect  public  health. 

In  the  meantime,  both  candidates  for  President  had  written 
warm  letters  of  endorsement.  I  quote  briefly  from  Mr.  William 
J.  Bryan: 

"Congress  should  appropriate  sufficient  money  to  carry 
on  investigations  into  diseases  national  in  their  scope." 

Mr.  Taft  in  his  letter  said: 

"The  American  Health  League  is  certainly  to  be  con- 
gratulated on  its  rapid  progress  in  numbers  and  recognition. 
It  is  through  such  an  enlistment  of  public  interest  that  Con- 
gress may  be  expected  to  enact  the  legislation  necessary  to 
enlarge  the  activities  of  the  Federal  Government  in  respect 
to  public  health. 

"I  hope  to  live  to  see  the  time  when  the  increased 
efficiency  in  the  public  health  service — Federal,  State  and 
Municipal — will  show  itself  in  a  greatly  reduced  death  rate. 
The  Federal  Government  can  give  a  powerful  impulse  to  this 
end  by  creating  a  model  public  health  service  and  making 
our  national  capital  a  model  sanitary  city, 

"With  most  cordial  wishes  for  the  success  of  your 
movement     .     .     .     ." 

In  President  Taft's  letter  of  acceptance,  he  said: 

"I  have  long  been  of  opinion  that  the  various  agencies 
of  the  national  government  established  for  the  preservation 
of  the  national  health,  scattered  through  several  departments, 
should  be  rendered  more  efficient  by  uniting  them  in  a  bureau 
of  the  government  under  a  competent  head,  and  that  I 
understand  to  be,  in  effect,  the  recommendation  of  both 
parties." 


15 

With  the  convening  of  Congress  in  December,  1908,  President 
Roosevelt  made  the  program  of  the  Committee  of  One  Hundred 
his  administration  poUcy.  He  authorized  the  announcement  of  this 
poHcy  before  a  conference  last  October  in  Washington,  called 
by  the  Committee  of  One  Hundred  at  which  were  represented  the 
American  Medical  Association,  the  Government  and  State  health 
bureaus  and  the  other  leading  health  organizations  of  the  United 
States.  Again,  in  his  December  message.  President  Roosevelt 
said: 

"It  is  highly  advisable  that  there  should  be  intelligent 
action  on  the  part  of  the  nation  on  the  question  of  pre- 
serving the  health  of  the  country.  .  .  .  The  dangers 
to  public  health  from  food  adulteration  and  from  any  other 
sources,  such  as  the  menace  to  the  physical,  mental,  and 
moral  development  of  children  from  child  labor,  should  be 
met  and  overcome.  There  are  numerous  diseases  which  are 
now  known  to  be  preventable,  which  are,  nevertheless,  not 
prevented.  The  recent  International  Congress  on  Tubercu- 
■  losis  has  made  us  painfully   aware  of  the   inadequacy  of 

American  public  health  legislation.  This  nation  cannot 
afford  to  lag  behind  in  the  world-wide  battle  now  being 
waged  by  all  civilized  people  with  the  microscopic  foes  of 
mankind,  nor  ought  we  longer  to  ignore  the  reproach  that 
this  Government  takes  more  pains  to  protect  the  lives  of  hogs 
and  cattle  than  of  human  beings.  The  first  legislative  step  to 
be  taken  is  that  for  the  concentration  of  the  proper  bureaus 
into  one  of  the  existing  departments.  I  therefore  urgently 
recommend  the  passage  of  a  bill  which  shall  authorize  a  re- 
distribution of  the  bureaus  which  shall  best  accomplish  this 
end." 

We  have  received  letters  from  one-third  of  the  Congressmen 
in  favor  of  such  legislation.  The  bill  is  in  the  hands  of  a  sub- 
committee of  the  House  at  the  present  time.  •  Among  those  who 
have  actively  aided  this  movement  in  Washington  are  President 
Roosevelt,  President-Elect  Taft,  Mr.  GiflFord  Pinchot,  Hon.  Charles 
D.  Walcott,  Secretary  of  the  Smithsonian  Institution,  Hon.  James  R. 
Garfield,  Hon.  George  Shiras,  III,  Dr.  Kober,  Dr.  Wiley,  and  Dr. 
Wyman  of  the  Public  Health  and  Marine  Hospital  Service,  in  whose 
hands  our  bill  now  rests.  These  men  are,  I  understand,  hopeful 
of  accomplishing  legislation  at  this  session. 

The  State  Governments  are  equally  interested.  Through  our 
representatives  in  Ohio,  a  resolution  endorsing  our  movement  was 


It) 

passed  in  that  State.  Our  health  planks  were  adopted  in  the  State 
Republican  platforms  of  Ohio  and  Delaware,  and  we  have  had  the 
cordial  endorsement  of  the  governors  of  some  twenty  states,  in- 
cluding such  widely  separated  states  as  Massachusetts,  Pennsylvania, 
Alabama,  Mississippi,  Michigan,  New  Mexico,  South  Dakota, 
Oregon  and  Washington.  Among  these  governors  I  will  quote 
only  two,  one  being  the  nearest  to,  and  the  other  the  farthest 
from  our  executive  office.  In  his  letter,  Governor  Woodruff  of 
Connecticut  said,  "I  am  glad  of  this  opportunity  to  endorse  the 
work  of  the  Committee  of  One  Hundred  on  National  Health  .  .  . 
I  consider  the  question  of  public  health  the  most  important  one  which 
our  country  has  before  it."  Governor  Freer  of  Hawaii  wrote,  "The 
people  of  Hawaii  .  .  .  are  in  a  position  to  realize  with  peculiar  force 
not  only  the  great  importance  of  the  subject  of  health,  but  also  the 
importance  of  the  co-operation  between  national,  state  and  terri- 
torial governments  in  this  matter.  ...  I  wish  the  Committee 
of  One  Hundred  every  success." 

In  the  peroration  of  President  Roosevelt's  famous  speech  be- 
fore the  Conference  on  the  Conservation  of  Natural  Resources,  at 
the  first  meeting  of  the  Conservation  Commission  at  Washington^ 
he  said: 

"Finally,  let  us  remember  that  the  conservation  of  our 
natural  resources,  though  the  gravest  problem  of  to-day,  is 
yet  but  part  of  another  and  greater  problem  to  which  this 
nation  is  not  yet  awake,  but  to  which  it  will  awake  in  time 
and  with  which  it  must  hereafter  grapple  if  it  is  to  live — the 
problem  of  national  efficiency." 

In  the  Conservation  Report  now  issued,  after  summarizing  the 
wastes  of  material  wealth,  the  Commission  has  gone  on  record  with 
these  words,  which  were  written  in  the  main  by  the  eloquent  Gov- 
ernor Blanchard  of  Louisiana : 

"Since  the  greatest  of  our  national  assets  is  the  health 
and  vigor  of  the  American  people,  our  efficiency  must  depend 
on  national  vitality  even  more  than  on  the  resources  of  the 
minerals,  lands,  forests  and  waters.  The  average  length  of 
human  life  in  different  countries  varies  from  less  than  25 
to  more  than  50  years.  This  span  of  life  is  increasing 
wherever  sanitary  sciences  and  preventive  medicine  are  ap- 
plied. It  may  be  greatly  extended.  Our  annual  mortality 
from  tuberculosis  is  about  150,000.  Stopping  three-fourths 
•  of  the  loss  of  life  from  this  cause  and  from  typhoid  and 


17 

other  prevalent  diseases  would  increase  our  average  length 

i  of  life  fifteen  years.     There  are  constantly  about  3,000,000 

persons  seriously  ill  in  the  United  States  of  whom  500,000 

are  consumptives.    More  than  half  this  illness  is  preventable. 

If  we  count  the  value  of  each  life  lost  at  only  $1,700,  and 

reckon  the  average  earning  lost  by  illness  at  $700  a  year  for 

grown  men,  we  find  that  the  economic  gain  from  mitigation 

of  preventable  disease  in  the  United  States  would  exceed 

$1,500,000,000  a  year.     This  gain,  or  the  lengthening  and 

strengthening  of  life  which  it  measures,  can  be  had  through 

medical  investigation  and  practice,  school  and  factory  hygiene, 

restriction  of  labor  by  women  and  children,  the  education  of 

the  people  in  both  public  and  private  hygiene,  and  through 

improving  the   efficiency   of  our  health   service,   municipal, 

state  and  national," 

This,  in  brief,  is  the  record  of  what  has  been  accomplished  in 

two  years  with  nothing  except  plans  to  start  with.     Much  more 

remains  to  be  accomplished.    The  complete  solution  of  the  public 

health  problem  requires  the  combination  of  three  factors:  First, 

the   activity   of    expert   enthusiasts;   second,   the    force   of   public 

opinion;    third,    money    with    which    to    pay    the    bills.       The 

Committee    of    One    Hundred    has    had    the    first    and    second 

— that  is,  the  workers  and  public  opinion.     The  proposed  alliance 

between  policy-holders,  your  companies  and  our  Committee  will 

bring  the  third  also,  the  sinews  of  war. 

It  should  be  emphasized  that  mere  money  can  do  little  alone 
in  such  a  country  as  ours.  We  must  have  expert  leaders  and  public 
following.  These,  as  organized  by  the  Committee  of  One  Hun- 
dred, are  at  your  service.  Our  membership  includes  expert 
workers  in  the — 

American  Association  for  the  Advancement  of  Science 
American  Medical  Association 
American  Public  Health  Association 
Federal,  State  and  City  Boards  and  Bureaus  of  Health 
National  Association  for  the  Study  and  Prevention  of  Tuber- 
culosis 
Rockefeller  Institute 

American  Society  of  Sanitary  and  Moral  Prophylaxis 
National  Child  Labor  Committee 
Presidents  and  Professors  in  the  principal  universities 
As  to  public  confidence,  we  have — besides  the  endorsements  of 
these  associations  and  the  backing  of  political  leaders  and  party 


i8 

platforms — the  co-operation  of  about  twenty  other  important 
organizations,  including  the  Associated  Fraternities  of  America  and 
the  United  Mine  Workers  of  America.  Such  a  degree  of  public 
confidence  is  an  asset  worth  having.  Public  confidence  is  valuable 
not  only  in  securing  public  health  legislation,  but  especially 
so  in  effecting  any  change  in  personal  hygiene,  the  habits  of 
living  in  a  community.  If,  for  instance,  the  people  are  to  sleep 
with  more  fresh  air  in  their  bedrooms,  they  can  be  led  to  do  so 
only  by  the  weight  of  medical  authority.  No  faddist  movement  will 
secure  rapid  reforms,  and  this  is  one  reason  why  reforms  so  often 
fail.  To  be  rapidly  successful,  reforms  must  spread  from  the 
top  and  not  from  the  bottom.  Western  civilization  has  made  rapid 
progress  in  Japan  because  the  reform  started  with  the  Mikado. 
In  China  it  failed  because  the  Empress  and  Court  opposed.  The 
secret  of  the  success  of  the  Committee  of  One  Hundred  has  been 
the  approval  of  the  leaders — political,  medical,  philanthropic  and 
social.  With  the  momentum  already  gained,  we  need  only  financial 
backing  to  achieve  greater  results  in  reducing  mortality  than  hitherto 
achieved  in  the  world.  It  is  primarily  a  question  of  judicious  pub- 
licity under  auspices  which  weigh  in  the  public  esteem.  It  is  easier, 
as  everyone  who  has  observed  public  movements  knows,  to  accom- 
plish a  large  reform  with  such  publicity  than  a  small  one.  Chicago 
could  not  clean  its  slaughter  houses,  but  when  the  whole  nation 
became  awake  to  slaughter  house  conditions,  they  were  immediately 
reformed,  in  part  at  least.  Since  the  agitation  for  the  national 
pure  food  law,  similar  pure  food  laws  have  been  passed  in  the  states 
where  before  it  was  impossible  to  secure  their  enactment.  Since 
the  recent  International  Congress  on  Tuberculosis  in  Washington, 
the  spread  of  the  anti-tuberculosis  movement  throughout  the 
country  has  been  many  times  more  rapid  and  enthusiastic  than  ever 
before.  There  never  was  a  time  more  favorable  for  securing 
tangible  results  in  improving  public  health  than  at  present,  and 
though  these  results  must  be  achieved  largely  through  legislation, 
the  legislation  cannot  be  secured  except  through  a  public  agitation 
such  as  the  Committee  of  One  Hundred  is  now  engaged  in  on  a 
small  scale. 


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